Thank you for choosing EyeCare Consultants as your health care provider. We are committed to building a successful relationship between our physicians and patients. Your clear understanding of our Financial Policy is a part of that professional relationship. We encourage you to ask if you have any questions about our fees, our policies, your responsibilities for payment or your responsibility to notify our office of any patient information changes (i.e. address, name, insurance information, etc.).
Co-Pays, Co-Insurance and Deductibles
The patient is expected to present a current insurance card at each visit. All co-payments and previous balances are due when you check in, unless previous arrangements have been made with a billing coordinator. We accept cash, check, Visa, MasterCard, Discover and Care Credit. Co-insurance and deductibles will be collected at the time services are rendered. If your previous balance is not paid or previous arrangements have not been discussed with the billing department, the examination, testing or surgery may be rescheduled or canceled.
We will bill your primary insurance company and secondary insurance as a courtesy to you. In order to properly bill your insurance company, we require that you disclose all insurance information, including primary and secondary insurance, as well as any change in your insurance information. Failure to provide complete insurance information may result in you being responsible for the entire bill. Although we can estimate what your insurance company may pay, the insurance company makes the final determination of your eligibility and benefits. You will be responsible to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment.
Referrals and Preauthorizations
If your insurance company requires a referral and/or preauthorization, we will do our best to obtain it for you. Ultimately, you are responsible for making sure that the referral and/or preauthorization is obtained. Failure to obtain it may result in a significantly lower payment from the insurance company, and the remaining balance will be your responsibility.
Self-pay accounts refer to:
- Patients without insurance coverage
- Patients covered by insurance plans in which the office does not participate
- Patients without an insurance card on file with us
- Liability cases*
*We do not accept attorney letters or contingency payments.
It is always your responsibility to know if our office participates in your plan. If there is a discrepancy in our information, we will always consider a patient self-pay unless proven otherwise. Self-pay patients will be required to cover services rendered at the initial appointment. If you have extenuating circumstances, please ask to speak with a billing coordinator to discuss a mutually agreeable payment plan. It is never our intention to cause hardship to our patients. We only seek to provide the best care possible with the least amount of stress.
The charge for a returned check is $25, payable by cash or money order. This will be applied to your account balance in addition to the insufficient funds amount. You may be placed on a cash-only basis following any returned check.
Patients, attorneys and insurance companies requesting copies of medical records will be charged as following, in accordance with Indiana State Law.
$20 labor fee
$1 per page (pages 1 through 10, only if no labor fee charged)
$0.50 per page (pages 11through 50)
$0.25 per page (pages 51 and higher)
Actual mailing costs (does not include “handling”)
$10 rush fee if records are to be provided within two business days
$20 certifying fee (if appropriate)
As always, if a collaborating physician (primary care, specialist or optometrist) requests portions of your record to assist in your care, there will be no charge.
The parent(s) or guardian(s) is responsible for full payment. Payment must be made prior to treatment of the minor. A signed Release to Treat Form may also be required for unaccompanied minors.
Outstanding Balance Policy
Our office sends three statements to any patient with a past-due account. If payment is not made on your account, we will make one phone call and send one letter. If no resolution can be made, the account will be sent to the collection agency or attorney, and the patient will be discharged from the practice. In the event an account is turned over for collections, the person financially responsible for the account will be responsible for all collections costs, including third party costs, attorney fees and court costs.
Regardless of any personal arrangements that a patient might have outside of our office, if you are over 18 years of age and receiving treatment, you are ultimately responsible for payment of your services. Our office will not bill any other personal party.
This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to contact us.